Concussions: Sometimes, Obsessing is Good

Posted By Shea & Shea - A Professional Law Corporation || 21-Jan-2016

I read with curiosity and some amount of skepticism the opinion published
in the New York Times advising parents to
Stop Obsessing Over Concussions. I was surprised to read this from a doctor, when it can be a life-changing
situation. My advice to parents – obsessing is good.

Why? A concussion is also called a
traumatic brain injury (TBI), and TBI is responsible for 2.2 million emergency department visits,
280,000 hospitalizations and 50,000 deaths per year.
[1]

I’m not arguing to stop letting our children play sports. I’ve
played contact sports, but I’ve also seen the changes that happen
when the brain is injured. Because of this, I’m quite comfortable
with exercising an “excessive sense of caution” – especially
when it comes to our children.

The author, Steven M. Rothman, advocates that a concussion “crisis”
has developed because concussion has acquired a “looser definition”
since 1977. This decades old definition required a temporary loss of consciousness.
Essentially Rothman urges that a “redefinition” is needed
such that a new level of head injury, one that the author calls “noncussion,” emerges.

Medicine has made incredible advances since 1977 regarding the unique symptoms
and treatment of concussive brain injuries. The variability of concussive
brain injuries changes drastically from patient to patient. Modern medicine
has long abandoned the requirement of a loss of consciousness to diagnose
a concussion. The “looser definition” that has evolved since
1977 is strongly supported in medical literature.

In 1998, the National Institute of Health (NIH) issued a consensus statement
on TBI. This statement made it clear that no loss of consciousness was
required to diagnose a concussion. In 2016, to suggest otherwise is to
ignore an entire body of peer-reviewed medical literature and decades
of advancement and understanding.

Randolph Evans, M.D., one of the authors of Prognosis of Neurological Disorders,
identifies the constellation of symptoms patients can experience following
a concussive brain injury. While certainly not an exhaustive list, concussive
brain injury involves: (1) cognitive symptoms of impaired memory, attention,
concentration, processing speed, difficulty maintaining focus, problems
with encoding information, and auditory processing; (2) physical symptoms
including headaches, nausea, visual disturbance, fatigue, dizziness, balance
problems; sensitivity to light and/or sound, and (3) emotional symptoms
including irritability, depression, and changes in personality. In the
student athlete, or even the pediatric setting, it is not hard to conceive
how any combination of these symptoms could potentially affect the child’s
return to learning. Not all patients suffer the entirety of the constellation;
all patients are as different as their residual symptoms. Dr. Evans underscores
that a loss of consciousness is not required to injure the brain or for
the post-concussive syndrome to result.[2]

According to the Mayo Clinic: “a concussion is a traumatic brain
injury, usually occurring after a blow to the head. Loss of consciousness
isn’t required for a diagnosis of concussion or post concussive
syndrome.”[3]

James Kelly, M.D., wrote about concussion and returning to play: “it
is important to correct a common misconception that concussion only occurs
if an individual is rendered unconscious.” He points out that concussive
brain injury is not determined by conventional neuroimaging studies like
CT or MRI scans and that “neuropsychological testing is our most
sensitive measure of cognitive dysfunction after concussion and it is
the most useful method of determining readiness to return to play.”[4]

An article published just this week[5] documented a 25 year-old student athlete who never played professional
sports, but did have a history of concussive injuries. Despite a 3.8 GPA
in high school, he began failing courses in college following another
concussion his freshman year. He eventually left school with a GPA of
1.9 and 12 credits short of a degree. Neuropsychological testing confirmed
his injury; CTE was confirmed pathologically.

The good news: most patients experience a full recovery following a concussion.
The bad news: some do not. For parents of children that suffer these injuries,
obsess over how they are functioning, not on the playing field but in
the classroom. Pay attention to their ability to return to learn. Find
the right doctor to evaluate and care for your child. Your child’s
future could depend on it. And that might be more important than the next big play.

[1] Centers for Disease Control and Prevention (CDC) (2015)
Report to Congress on Traumatic Brain Injury in the United States: Epidemiology
and Rehabilitation. National Center for Injury Prevention and Control; Division of Unintentional
Injury Prevention. Atlanta, GA., GA

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